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MA11.076g, Removal of Breast Implants
Act
by Jul 9, 2025
Effective date
Jul 9, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated MA11.076g to MA11.076h, removing coverage language that previously allowed reconstruction/replacement of breast implants for traumatic or surgically created deficits. CPT code 19370 was removed, and ICD-10 diagnosis codes were updated to add BIA-ALCL and gynecomatia-related codes while removing sequela and prosthetic status codes. The policy now emphasizes that removal is covered only when medical necessity criteria are met, with symmetry coverage available only when one implant requires removal due to a covered indication.
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What to do
by Jul 9, 2025 · 6 steps
01Billing team must update billing system to remove CPT 19370 from all claim submission logic for Independence Blue Cross Medicare Advantage plans.
02Remove ICD-10 codes T85.41XS, T85.42XS, T85.43XS, T85.44XS, T85.49XS, T85.79XS, Z44.30, Z44.31, Z44.32, Z90.10, Z90.11, Z90.12, and Z90.13 from valid diagnosis code lists for breast implant removal claims.
03Add new ICD-10 codes C50.911, N61.20, N61.21, N61.22, and N61.23 to valid diagnosis code lists.
04Update internal documentation and provider communication to clarify that reconstruction/replacement of implants for traumatic or surgically created deficits is no longer covered language.
05Billing staff must deny claims for bilateral implant removal when only unilateral implant meets removal criteria unless BIA-ALCL diagnosis is present.
06Update denial letters to reference current policy language.
If missed: Failure to implement these changes will result in improper claim submissions and potential overpayments to providers.
Codes mentioned
19328193301937119370C50.911N61.20N61.21N61.22N61.23T85.41XST85.42XST85.43XST85.44XST85.49XST85.79XSZ44.30Z44.31Z44.32Z90.10Z90.11Z90.12Z90.13
Original notice
MA11.076g, Removal of Breast Implants
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA11.076h, Removal of Breast ImplantsLowEffective Oct 1, 2025 · Medical PolicyMA11.076h, Removal of Breast ImplantsLowEffective Oct 1, 2025 · Medical Policy11.08.14o, Removal of Breast ImplantsMediumEffective Oct 1, 2024 · Medical Policy11.08.14p, Removal of Breast ImplantsLowEffective Oct 1, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list
Related policy hubs
Independence Blue Cross policiesNJ policy changesPlastic SurgeryGeneral SurgeryOncologyCode 19328Code 19330Code 19371Code 19370Code C50.911Code N61.20Code N61.21Code N61.22Code N61.23Code T85.41XSCode T85.42XSCode T85.43XSCode T85.44XSCode T85.49XSCode T85.79XSCode Z44.30Code Z44.31Code Z44.32Code Z90.10Code Z90.11Code Z90.12Code Z90.13